Data analysis for differentiating temporo mandibular disorders (TMD) pain from tooth pain

The factors differentiating temporomandibular disorders (TMD) pain from tooth pain is of interest to dentists. Prior to receiving therapy, participants answered the six-question TMD Pain Screener questionnaire. Applying validated Diagnostic Guidelines for TMD (DC/TMD), an orofacial pain specialist and endodontic resident with board certification performed endodontic and TMD examinations. In our study, sensitivity was higher for TMD screener regarding identification of all types of TMDs (0.94 (0.80-0.97), TMD pain not referring to teeth (0.94 (0.76-0.98), TMD pain referring to teeth only (0.94 (0.64-1.00)). TMD Pain Screener questionnaire can be applied in identification of TMDS in patient seeking endodontic therapy.


Background:
Although it may seem similar to endodontic pain, temporomandibular disorders (TMD) prevalence and their role in endodontic patients is not being adequately studied [1-3].Toothache is the most common painful complaints in the orofacial area.Most toothache is attributed to odontogenic inflammation, within and around the tooth, and it constitutes one of the main causes of dental visits for patients [4][5][6].The word "odontogenic pain" refers to a variety of possible diagnoses, such as acute apical abscesses, painful apical periodontitis, and painful irreversible pulpitis being a pulpal diagnosis [3][4][5].It is possible for a tooth pain to originate from a source other than the mouth due to pain being referred from other structures.TMDs have been found to transmit pain towards the dentoalveolar structures, for instance [6-8].Patients with TMD may have pain, which may lead them to consult with different specialists.TMD is more prevalent among women because of hormonal fluctuations and the increased impact of psychosocial variables [7-11].It is most commonly observed in individuals between the ages of 20 and 40years.Therefore, it can be said that TMD is an issue of civilization that may get worse because of a fast-paced lifestyle, constant stress, and improper operation of the masticatory apparatus [11][12][13][14] A study shows that there is diversity in the etiology of pain associated with TMJ disorders, including central and peripheral sources.Treatment choices should be guided by their discovery that TMD is associated with anatomical and functional alterations in the brain's prefrontal cortex, basal ganglia, and primary somatosensory cortex

Methods and Materials:
We enlisted two hundred individuals who were seeking endodontic therapy for tooth pain.Prior to receiving therapy, participants answered the six-question TMD Pain Screener.
Applying validated Diagnostic Guidelines for TMD (DC/TMD), an orofacial pain specialist and endodontic resident with board certification performed endodontic and TMD examinations.

Inclusion criteria: [1]
Patients reporting to dental clinic with tooth pain

Outcomes:
Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were assessed on the basis of findings obtained and information gathered from the questionnaire filled by patients.Outcomes were analysed for three clinical situations: [1] TMD pain not referred to teeth only [2] TMD pain referred to teeth only [3] All types of TMDS.

Statistical analysis:
The data was tabulated and feed in MS excel sheet.The data was subjected for statistical analysis using SPSS version 21 software.
The findings were presented in the form of confidence interval (CI) for parameters like Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV).all masticatory structures and its potential to either disclose or worsen temporomandibular disorders, stress is an indisputable contributing factor [14-21].These questionnaires continue to be used in epidemiological research intended to determine the magnitude of tooth pain frequency since the prevalence can be recalculated using the known error rates [11][12][13][14][15].A word of concern should be issued because the huge confidence intervals (CIs) introduce a significant degree of uncertainty into the estimate, which may limit the applicability of this approach [10-18].The best option for separating patients with odontogenic pain from those with TMD pain in clinical environments where TMD prevalence is not particularly low and for application in epidemiological studies is the 6-item TMD screener, which has a modest specificity and great sensitivity [3-7].

Conclusion:
TMD Pain Screener questionnaire can be applied in identification of TMDS in patient seeking endodontic therapy.

[ 19 -
21].Patients with TMD frequently experience their condition as a headache because of irregularities in TMJ, muscles of mastication, along with other nearby tissues [22-25].

.
Stress is an undeniable contributing element, since it negatively impacts all masticatory structures and, if it persists, can reveal or exacerbate temporomandibular problems [

13-16].It is
The results of the research show that people who have tension headaches or migraines are more likely to experience typical TMD symptoms.Additionally, it has been demonstrated that individuals with TMD are more prone to get migraines, and that having both conditions at the same time makes each condition's symptoms worse [

15-18].
prevalence.Dentists must take into account NonoDontogenic causes of pain when testing for dental pathology come back negative for an odontogenic complaint [15-18].It may be useful to detect such individuals in routine dentistry practice by using a short, valid screening tool to help determine the most frequent NonoDontogenic cause of "tooth" pain in patients seeking endodontic therapy [18-23].There are some tools like TMD Pain Screener questionnaire and Dental Pain Questionnaire for identifying TMDS [19-25].But very few studies has been conducted to use these tools for identifying TMDS in patient seeking endodontic therapy.Therefore, it is of interest to evaluate the accuracy of a TMD Pain screener questionnaire in recognizing patient's TMD pain among patients seeking endodontic therapy for tooth pain.

[ 2 ]
Patient demanding endodontic therapy for complain of tooth pain.Using psychometric techniques for item selection, it was created in two versions: a long (6-item) version and a short (3item) version.Its validity was assessed among 504 participants.

Table 2 : CI values of different Parameters for accuracy of TMD screener for three
To identify TMDS, there are tools such as the dental pain Questionnaire and the TMD Pain Screener questionnaire.
[18][19][20][21][22][23][24][18][19] symptom in the orofacial region is toothache, accounting for 12% of cases.Toothache is one of the primary reasons individuals' visits the dentist and it is primarily caused by odontogenic inflammation inside and around the tooth [11-17].Temporomandibular joint (TMD) pain is the most common NonoDontogenic cause of "tooth" pain, and it can come from the joints, surrounding tissues, or the masticatory muscle [13-18].Odontogenic discomfort is common, thus dentists are trained to recognize and manage it.When testing for dental pathology yields negative results for an odontogenic complaint, dentists must consider NonoDontogenic causes of discomfort [12-16].Using a brief, valid screening tool to identify the most common NonoDontogenic source of "tooth" pain in patients seeking endodontic therapy may assist identify such patients in routine dentistry practice[11][12][13][14][15][16][17][18][19].The prevalence of TMD and their role in endodontic patients are not well studied, despite the fact that they may seem similar to endodontic pain [16-23].[19][20][21][22][23][24][25][26].Another study also showed similar results with TMD Pain Screener questionnaire[18][19][20][21][22][23][24].According to a study, the etiology of pain linked to TMJ issues is diverse and can come from both central and peripheral sources.The finding that TMD is linked to structural and functional changes in the brain's prefrontal cortex, basal ganglia, and primary somatosensory fast-paced lifestyle, on-going stress, and dysfunctional masticatory apparatus [10-15].Given its detrimental effects on